Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluating Chronic Care of Public Health Centers in a Metropolitan City

만성질환 관리 평가도구를 이용한 보건소 만성질환 관리수준 평가

  • Choi, Yong-Jun (Department of Social and Preventive Medicine, Hallym University College of Medicne) ;
  • Shin, Dong-Soo (Division of Nursing, Hallym University) ;
  • Kang, Minah (Department of Public Administration, Ewha Womans University College of Social Sciences) ;
  • Bae, Sang-Soo (Department of Social and Preventive Medicine, Hallym University College of Medicne) ;
  • Kim, Jaiyong (Health Services Research Center, Hallym University)
  • 최용준 (한림대학교 의과대학 사회의학교실) ;
  • 신동수 (한림대학교 간호학부) ;
  • 강민아 (이화여자대학교 사회과학대학 행정학과) ;
  • 배상수 (한림대학교 의과대학 사회의학교실) ;
  • 김재용 (한림대학교 사회의학연구소)
  • Received : 2014.10.21
  • Accepted : 2014.12.17
  • Published : 2014.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: To evaluate the quality of chronic care provided by public health centers located in a South Korean metropolitan city using a modified Assessment of Chronic Illness Care (ACIC). Methods: We conducted self-evaluation surveys and collected data using a modified ACIC from twenty five public health centers. Cultural validity of the original ACIC was examined by the public health and nursing science experts. Based on expert reviews, cognitive interviews, pre-test results, five items of the original ACIC that were not relevant were deleted. The response scale was changed from twelve-point Likert scale to Guttman scale but its scoring system was maintained. Results: Eighty eight percent of public health centers in this study reported that their overall quality of chronic care was at a limited or basic level. About 68% of the centers reported that the organization was as reasonably good or fully developed to provide chronic care. On the other hand, 96% of the public health centers reported that the clinical information system was at a very limited or basic support level. The decision support, the integration of Chronic Care Model components, the delivery system design, the community linkages, and the self-management support were evaluated as limited or basic level of support by more than half of the public health centers, respectively. Conclusion: In a metropolitan area of South Korea, quality of chronic care in public health centers was not found to reach acceptable levels of services. It is critical to enhance the quality of chronic care in public health centers.

Keywords

References

  1. Yoon SJ, Ha BM, Kim CY. Measuring the burden of hypertension using DALY in Korea. Korean J Health Policy Admin 2001;11(3):89-101.
  2. Lee TJ, Kim J, Sung J. Estimation of disability-adjusted life years of major cardiovascular diseases in Korea. Korean Health Econ Rev 2002;8(1):91-106.
  3. Jung YH, Ko S. Estimating socioeconomic costs of five major diseases. Korean J Public Financ 2004;18(2):77-104.
  4. Ministry of Health and Welfare. Comprehensive management plan for cardio- and cerebrovascular diseases. Seoul: Ministry of Health and Welfare; 2006.
  5. Ministry of Health and Welfare. Comprehensive management plan for cardio- and cerebrovascular diseases(2011-2015). Seoul: Ministry of Health and Welfare; 2011.
  6. Lee HJ, Lee JJ, Hwang TY, Kam S. Development and evaluation of a community staged education program for the cardiocerebrovascular disease high-risk patients. J Agric Med Community Health 2012;37(3):167-180. https://doi.org/10.5393/JAMCH.2012.37.3.167
  7. Choeng W, Yim J, Oh DK, Im JS, Ko KP, Kim YM. Effects of chronic disease management based on clinics for blood pressure or glycemic control in patients with hypertension or type 2 diabetes mellitus. J Agric Med Community Health 2013;38(2):108-115. https://doi.org/10.5393/JAMCH.2013.38.2.108
  8. Lee YW, Hong YP. The second year effectiveness evaluation of the Gwangmyeong-si CVD patient registry project. Cheongju: Korea Centers for Disease Control and Prevention; 2010.
  9. Bae SS, Kim KM, Kim G, Kim JY, Park MS, Park YB, et al. A study on control and prevention of cardiovascular diseases in Seoul. Seoul: Seoul Metropolitan Government; 2010.
  10. Park SW, Kim DJ, Min KW, Baik SH, Choi KM, Park IB, et al. Current status of diabetes management in Korea using National Health Insurance Database. J Korean Diabetes Assoc 2007;31(4):362-367. DOI: http://dx. doi.org/10.4093/jkda.2007.31.4.362
  11. Wagner EH, Austin BT, Von Korff M. Improving outcomes in chronic illness. Manag Care Q 1996;4(2):12-25.
  12. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q 1996;74(4):511-544. DOI: http://dx.doi.org/10.2307/3350391
  13. Jung YH, Ko S, Kim EJ. A study on the effective chronic disease management. Seoul: Korea Institute for Health and Social Affairs; 2013.
  14. Improving Chronic Illness Care. The Chronic Care Model [Internet]. Seattle (WA): MacColl Center for Health Care Innovation; 2014 [cited 2014 Mar 23]. Available from: http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2.
  15. Singh D, Ham C; NHS Institute for Innovation and Improvement. Improving care for people with long-term conditions: a review of UK and international frameworks. Birmingham: University of Birmingham, Health Services Management Centre; 2006.
  16. Nolte E, Knai C, McKee M. Managing chronic conditions: experience in eight countries. Copenhagen: World Health Organization Regional Office for Europe; 2008.
  17. Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res 2002;37(3):791-820. DOI: http://dx.doi.org/10.1111/1475-6773.00049
  18. Si D, Bailie R, Connors C, Dowden M, Stewart A, Robinson G, et al. Assessing health centre systems for guiding improvement in diabetes care. BMC Health Serv Res 2005;5:56. DOI: http://dx.doi.org/10.1186/1472-6963-5-56
  19. Drabo KM, Konfe S, Macq J. Assessment of the health system to support tuberculosis and AIDS care: a study of three rural health districts of Burkina Faso. J Public Health Africa 2010;1:e4. DOI: http://dx.doi.org/10.4081/ jphia.2010.e4
  20. Steurer-Stey C, Frei A, Schmid-Mohler G, Malcolm-Kohler S, Zoller M, Rosemann T. Assessment of Chronic Illness Care with the German version of the ACIC in different primary care settings in Switzerland. Health Qual Life Outcomes 2010;8:122. DOI: http://dx.doi.org/10.1186/1477-7525-8-122
  21. Cramm JM, Strating MM, Tsiachristas A, Nieboer AP. Development and validation of a short version of the Assessment of Chronic Illness Care (ACIC) in Dutch disease management programs. Health Qual Life Outcomes 2011;9:49. DOI: http://ddx.doi.org/10.1186/1477-7525-9-49
  22. Steinhaeuser J, Goetz K, Ose D, Glassen K, Natanzon I, Campbell S, et al. Applicability of the Assessment of Chronic Illness Care (ACIC) instrument in Germany resulting in a new questionnaire: questionnaire of chronic illness care in primary care. BMC Health Serv Res 2011;11:164. DOI: http: //dx.doi.org/10.1186/1472-6963-11-164
  23. Steinhaeuser J, Miksch A, Ose D, Glassen K, Natanzon I, Szecsenyi J, et al. Questionnaire of chronic illness care in primary care-psychometric properties and test-retest reliability. BMC Health Serv Res 2011;11:295. DOI: http://dx.doi.org/10.1186/1472-6963-11-295
  24. Steurer-Stey C, Frei A, Schmid-Mohler G, Malcolm-Kohler S, Zoller M, Rosemann T. The German version of the Assessment of Chronic Illness Care: instrument translation and cultural adaptation. J Eval Clin Pract 2012;18(1):1-4. DOI: http://dx.doi.org/10.1111/j.1365-2753.2010.01511.x
  25. Gomutbutra P, Aramrat A, Sattapansri W, Chutima S, Tooprakai D, Sakarinkul P, et al. Reliability and validity of a Thai version of assessment of chronic illness care (ACIC). J Med Assoc Thai 2012;95(8):1105-1113.
  26. Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care 2005;43(5):436-444. DOI: http://dx.doi.org/10. 1097/01.mlr.0000160375.47920.8c https://doi.org/10.1097/01.mlr.0000160375.47920.8c
  27. Rosemann T, Laux G, Droesemeyer S, Gensichen J, Szecsenyi J. Evaluation of a culturally adapted German version of the Patient Assessment of Chronic Illness Care (PACIC 5A) questionnaire in a sample of osteoarthritis patients. J Eval Clin Pract 2007;13(5):806-813. DOI: http://dx.doi.org/10.1111/j.1365-2753.2007.00786.x
  28. Aragones A, Schaefer EW, Stevens D, Gourevitch MN, Glasgow RE, Shah NR. Validation of the Spanish translation of the Patient Assessment of Chronic Illness Care (PACIC) survey. Prev Chronic Dis 2008;5(4):A113.
  29. Wensing M, van Lieshout J, Jung HP, Hermsen J, Rosemann T. The Patients Assessment Chronic Illness Care (PACIC) questionnaire in The Netherlands: a validation study in rural general practice. BMC Health Serv Res 2008;8:182. DOI: http://dx.doi.org/10.1186/1472-6963-8-182
  30. Gugiu PC, Coryn C, Clark R, Kuehn A. Development and evaluation of the short version of the Patient Assessment of Chronic Illness Care instrument. Chronic Illn 2009;5(4):268-276. DOI: http://dx.doi.org/10.1177/1742395309348072
  31. Carryer J, Budge C, Hansen C, Gibbs K. Modifying the PACIC to assess provision of chronic illness care: an exploratory study with primary health care nurses. J Prim Health Care 2010;2(2):118-123. https://doi.org/10.1071/hc10118
  32. Gugiu C, Coryn CL, Applegate B. Structure and measurement properties of the Patient Assessment of Chronic Illness Care instrument. J Eval Clin Pract 2010;16(3):509-516. DOI: http://dx.doi.org/10.1111/j.1365-2753.2009.01151.x
  33. Maindal HT, Sokolowski I, Vedsted P. Adaptation, data quality and confirmatory factor analysis of the Danish version of the PACIC questionnaire. Eur J Public Health 2012;22(1):31-36. DOI: http://dx.doi.org/10.1093/eurpub/ckq188
  34. Goetz K, Freund T, Gensichen J, Miksch A, Szecsenyi J, Steinhaeuser J. Adaptation and psychometric properties of the PACIC short form. Am J Manag Care 2012;18(2):e55-e60.
  35. Cramm JM, Nieboer AP. Factorial validation of the Patient Assessment of Chronic Illness Care (PACIC) and PACIC short version (PACIC-S)among cardiovascular disease patients in the Netherlands. Health Qual Life Outcomes 2012;10:104. DOI: http://dx.doi.org/10.1186/1477-7525-10-104
  36. Rick J, Rowe K, Hann M, Sibbald B, Reeves D, Roland M, et al. Psychometric properties of the Patient Assessment Of Chronic Illness Care measure: acceptability, reliability and validity in United Kingdom patients with long-term conditions. BMC Health Serv Res 2012;12:293. DOI: http://dx.doi.org/10.1186/1472-6963-12-293
  37. Drewes HW, de Jong-van Til JT, Struijs JN, Baan CA, Tekle FB, Meijboom BR, Westert GP. Measuring chronic care management experience of patients with diabetes: PACIC and PACIC+ validation. Int J Integr Care 2012; 12:e194.
  38. World Health Organization. Innovative care for chronic conditions: building blocks for action. Geneva: World Health Organization; 2002.
  39. Guttman L. A basis for scaling qualitative data. Sociol Rev 1944;9(2):139-150. https://doi.org/10.2307/2086306
  40. Babbie E. The practice of social research. Belmont (CA): Wadsworth Publishing; 2003.
  41. Adams SA, Ashburn A, Pickering RM, Taylor D. The scalability of the Rivermead Motor Assessment in acute stroke patients. Clin Rehabil 1997; 11(1):42-51. DOI: http://dx.doi.org/10.1177/026921559701100107
  42. Menzel H. A new coefficient for scalogram analysis. Public Opin Q 1953; 17(2):268-280. https://doi.org/10.1086/266460
  43. Gothwal VK, Wright TA, Lamoureux EL, Pesudovs K. Guttman scale analysis of the distance vision scale. Invest Ophthalmol Vis Sci 2009;50(9):4496-4501. DOI: http://dx.doi.org/10.1167/iovs.08-3330
  44. World Health Organization. Process of translation and adaptation of instruments [Internet]. Geneva: World Health Organization; 2014 [cited 2014 Mar 27]. Available from: http://www.who.int/substance_abuse/research_tools/translation/en/.
  45. Kaissi AA, Parchman M. Assessing chronic illness care for diabetes in primary care clinics. Jt Comm J Qual Patient Saf 2006;32(6):318-323. https://doi.org/10.1016/S1553-7250(06)32041-7
  46. Parchman ML, Pugh JA, Wang CP, Romero RL. Glucose control, self-care behaviors, and the presence of the chronic care model in primary care clinics. Diabetes Care 2007;30(11):2849-2854. DOI: http://dx.doi.org/10.2337/ dc06-2516
  47. Parchman ML, Zeber JE, Romero RR, Pugh JA. Risk of coronary artery disease in type 2 diabetes and the delivery of care consistent with the chronic care model in primary care settings: a STARNet study. Med Care 2007; 45(12):1129-1134. DOI: http://dx.doi.org/10.1097/mlr.0b013e318148431e
  48. Parchman M, Kaissi AA. Are elements of the chronic care model associated with cardiovascular risk factor control in type 2 diabetes? Jt Comm J Qual Patient Saf 2009;35(3):133-138. https://doi.org/10.1016/S1553-7250(09)35017-5
  49. Campbell MK, Tessaro I, Gellin M, Valle CG, Golden S, Kaye L, et al. Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network. J Cancer Surviv 2011;5(3):271-282. DOI: http://dx. doi.org/10.1007/s11764-011-0180-z
  50. Salkind N. Encyclopedia of research design. Thousand Oaks: Sage; 2010.
  51. Pearson ML, Wu S, Schaefer J, Bonomi AE, Shortell SM, Mendel PJ, et al. Assessing the implementation of the chronic care model in quality improvement collaboratives. Health Serv Res 2005;40(4):978-996. DOI: http://dx.doi.org/10.1111/j.1475-6773.2005.00397.x
  52. Bowen JL, Provost L, Stevens DP, Johnson JK, Woods DM, Sixta CS, et al. Assessing Chronic Illness Care Education (ACIC-E): a tool for tracking educational re-design for improving chronic care education. J Gen Intern Med 2010;25 Suppl 4:S593-S609. DOI: http://dx.doi.org/10.1007/s11606-010-1385-y
  53. Stevens DP, Bowen JL, Johnson JK, Woods DM, Provost LP, Holman HR, et al. A multi-institutional quality improvement initiative to transform education for chronic illness care in resident continuity practices. J Gen Intern Med 2010;25 Suppl 4:S574-80. DOI: http://dx.doi.org/10.1007/s11606-010-1392-z
  54. Landis SE, Schwarz M, Curran DR. North Carolina family medicine residency programs' diabetes learning collaborative. Fam Med 2006;38(3): 190-195.
  55. Solberg LI, Crain AL, Sperl-Hillen JM, Hroscikoski MC, Engebretson KI, O'Connor PJ. Care quality and implementation of the chronic care model: a quantitative study. Ann Fam Med 2006;4(4):310-316. DOI: http://dx.doi.org/10.1370/afm.571
  56. Yu GC, Beresford R. Implementation of a chronic illness model for diabetes care in a family medicine residency program. J Gen Intern Med 2010; 25 Suppl 4:S615-S619. DOI: http://dx.doi.org/10.1007/s11606-010-1431-9
  57. Leykum LK, Palmer R, Lanham H, Jordan M, McDaniel RR, Noel PH, et al. Reciprocal learning and chronic care model implementation in primary care: results from a new scale of learning in primary care. BMC Health Serv Res 2011;11:44. DOI: http://dx.doi.org/10.1186/1472-6963-11-44
  58. McEvoy P, Escott D, Bee P. Case management for high-intensity service users: towards a relational approach to care co-ordination. Health Soc Care Community 2011;19(1):60-69. DOI: http://dx.doi.org/10.1111/j.1365-2524. 2010.00949.x
  59. Patel NK, Parchman ML. The chronic care model and exercise discussions during primary care diabetes encounters. J Am Board Fam Med 2011; 24(1):26-32. DOI: http://dx.doi.org/10.3122/jabfm.2011.01.100137
  60. Cramm JM, Nieboer AP. Disease-management partnership functioning, synergy and effectiveness in delivering chronic-illness care. Int J Qual Health Care 2012;24(3):279-285. DOI: http://dx.doi.org/10.1093/intqhc/mzs004
  61. Noel PH, Lanham HJ, Palmer RF, Leykum LK, Parchman ML. The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams. Health Care Manage Rev 2013; 38(1):20-28. DOI: http://dx.doi.org/10.1097/HMR.0b013e3182497262
  62. Parchman ML, Noel PH, Culler SD, Lanham HJ, Leykum LK, Romero RL, et al. A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Sci 2013;8:93. DOI: http://dx.doi.org/10.1186/1748-5908-8-93
  63. Sunaert P, Bastiaens H, Feyen L, Snauwaert B, Nobels F, Wens J, et al. Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience". BMC Health Serv Res 2009;9:152. DOI: http://dx.doi/org/10.1186/1472-6963-9-152
  64. Von Goeler DS, Rosal MC, Ockene JK, Scavron J, De Torrijos F. Self-management of type 2 diabetes: a survey of low-income urban Puerto Ricans. Diabetes Educ 2003;29(4):663-672. DOI: http://dx.doi.org/10.1177/014 572170302900412
  65. Jerant AF, von Friederichs-Fitzwater MM, Moore M. Patients' perceived barriers to active self-management of chronic conditions. Patient Educ Couns 2005;57(3):300-307. DOI: http://dx.doi.org/10.1016/j.pec.2004.08.004
  66. Carbone ET, Rosal MC, Torres MI, Goins KV, Bermudez OI. Diabetes self-management: perspectives of Latino patients and their health care providers. Patient Educ Couns 2007;66(2):202-210. DOI: http://dx.doi.org/10.1016/j.pec.2006.12.003
  67. Ha JY, Yee OH, Son HM. Chronic disease in later life: a qualitative research. Qual Res 2011;12(1):11-24.
  68. Duke SA, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2009;(1): CD005268. DOI: http://dx.doi.org/10.1002/14651858.CD005268.pub2
  69. Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005;(2):CD003417.
  70. Steinsbekk A, Rygg LO, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus: a systematic review with meta-analysis. BMC Health Serv Res 2012;12:213. DOI: http://dx.doi.org/10.1186/1472-6963-12-213
  71. Chung Y, Lee GH, Song HJ. A study for producing health indicators by using the integrated PHIS (Public Health Information System). Seoul: Korea Institute for Health and Social Affairs; 2011.
  72. Jang YM, Ryu SW, Park SM, Lee DY, Kim WJ, Yang MY. A study on implementing local specialized public health service to Public Health Information System. Seoul: Korea Health and Welfare Information Service; 2011.
  73. Bae SS, Lee SW, Kim JW, Lee SM. New approach to strengthening of local public health system. Seoul: Research Institute for Healthcare Policy; 2010.
  74. Donabedian A. An introduction to quality assurance in health care. New York: Oxford University Press; 2003.